Provider Demographics
NPI:1235393968
Name:BIETHMAN, JANIS MARIA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:MARIA
Last Name:BIETHMAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STE GENEVIEVE DR
Mailing Address - Street 2:P.O. BOX 468
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1434
Mailing Address - Country:US
Mailing Address - Phone:573-883-2751
Mailing Address - Fax:573-883-7796
Practice Address - Street 1:800 STE GENEVIEVE DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1434
Practice Address - Country:US
Practice Address - Phone:573-883-2751
Practice Address - Fax:573-883-7796
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027853133V00000X
IL164.001367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered